Provider Demographics
NPI:1912754912
Name:BHOGAL, JESDIP SINGH
Entity Type:Individual
Prefix:
First Name:JESDIP SINGH
Middle Name:
Last Name:BHOGAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 WHITE ALDER DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-5815
Mailing Address - Country:US
Mailing Address - Phone:909-859-9601
Mailing Address - Fax:
Practice Address - Street 1:3601 SAN DIMAS ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1405
Practice Address - Country:US
Practice Address - Phone:661-323-2894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist